HomeMy Public PortalAbout9560BISBY ST_Building (8) yyq.RKERS'COMPENS.A1lON.9ECLa`f°TiQN. y 41 .S_;ip-`
4, .i herlFby affirm that I have.a 4ertl fJrAte of.;4orngnt-,to,self _ A�P L �-T I � P E R IT
Insure, or a certrficate 61 Workers' Cornpensatlgn Insurance, -+ Q rV�
or a certified copy thereof (Sec_ 3800; Lala. f _ - -
cy 2 , / COUNTY OF LOS ANGELES BUILDING:
SAFETY
Poll No. h 7 TCompa nyS� "�J J /�
Certified copy Is.hereby#umishecl + .a:`.• FOR APPLICANT TO FILL. ADDRESSBU UDI Y
_ �,DDR>_ss
Certified copy Is fl(ed;with.tha county'bZlydlh? Inapec- BUILDING s l
tion ant.
a
AE
Data -Applrctint Cm z,P , - b L
.of _
I CAl•E OF•E)EMMION FROM _. . .. i ._.
COMPENSATION INSURANCE r S1zE of Lor Now ON loY sr
(This taction need not be.com leted If tha permit is�for one_- - - _ ._.
by died do I tars (;1 QO)or.less.
"12T� y BLOCK LOT NO. BOOK �'t PARCEL,
TEL
Mik
I certify•that Irti the performance Pf the wprk,fpr,v�hlch.ihls SbWNSZ NO. 3 NO. --
U5E
permitls_Issiigd, I shall-not employ any person In any.niQnner• _ _ -S- -- ---- CO LI I
UrIZ
so'as to becbme'sublact to the Wotkers'Corn ia6'tlon'LQws.` ��"��
_ r.. Cm --- 4 r-- --ZIP__.. _ f
N ITI(CE TO APPLItWt�' If, after rriaklb6 thls'Ceitlflt" of ARCHITECT TE1DIsudcT__. UPt T, - . -R2�
fxeniptlon, you should become' sublaZt -to-'thbl Wor{afi - 7 /�
Compehsatidn�pnovlslons'of tho Labor Code,-you•mutt-fbrth- ADDRESS .3. VU ��% - -
with_comply with-pdch,pmvlslons.or r.ifils permlt.shau be - -•-
n sTAnsnuL CL./�SSIFICl�710N; APT.
deemed revoked. �, r CONTRACTOR c NO.3 _
LICENSED CONVACfiORS 15EC1,AR.AT}OfJ.. c __ ._. ._.. _ �- _ _ LASS UNITS
I hereby.aifirm that I Qm llcep#bd under prov)slpnsof Chapter 9 ADORE S ��z� NO.
(commwxlnq with Sedlon 7000 df MYWon�of the Busiroe"and _ _ _ SEWER�_ ,
Professions Code, olid my Ilcerise 6 In Bill 6-cd and.e f¢�t. CLASS O - - - y,� T
_ �,, __ ~BIC. PG.
License Nyjn�er Ur-CIL SIZE STORIES FAMILIES.
� �. - DESCRIPTION•OFWORIC- - - NEW
•,Contractor ! ► b ;
Am ,
I am exempt under Sec-
B.
ec
- - - -- - -
B.BP.0 for ifiu reason..
USE OF
-- �dtd: IXlSllhlG BLDG. }' z DEMOI
Sldrxrturo tet+' �?L� (�F L /�-Cl.►'L- /INTI
NOTEL. /V FINAL --
OWNER I DECL ARATION DATES- y �-
_ - - ._
I hpreby affirm that I am exempt-frorri We Cogtrocto�s License ADDRESS
!, R . _;. r .;.,r.: u .•
Law for the following reowh[(Sbctton 7031.5, 13U6lnose and K
Professlont Code): PRESENT
BUILDING L i
I, as owner of the property,-or my emproyees.�vith ADDRESS
}
wages as their sale compensation,will do the work LOCALITY i 9 .A
the structure Is not Intended or offered V sale(Section _
7044, Buslnau and Profe#slons Code):- .OVlN.. - ._ - - , _�_ — _.. . a # ° °'a.o • T. 1
❑_ 1, as owaer of the property, am exclusively coniractlnq
_ with licensed contractor+ to coAstrud the prolbtt (Sec- . - - - - - -'- - 1 -.�-o e--60,-50
tion 7044, Buslnbss ao Profeetlons Code). ADDRESS i
CONSTRUCTION LENDINCQ AGENCY SET YARD HVN -TOTALPROF- LINE WrDTH - _ _- - e.'• 0'6`�rj�
I hereby afflrm that there is a coattruction lending agency for FRONT
th-e performance of the work for.which this permit Is issued P.L - - - - -^ t 1 - - {)•Q 7 is (�"
jSec. 3097, Civ: C). SIDE ,. a
8 - - -P.L_
Lender's Name -- -
.. P.C,- >< � � - - - --. ._.. Permit Fee
8 . LDMA Rif. /
Lenders Address
I certify that I have-'rood this-application and state that the - -- --
Iswance Fee LDMA P/C/
above InformaHon Is correct..)agree to compry with all Co6hty Invow Won Fee - - /D - `
_.prp
rdlncgs and.State laws relat[N_to bulldlpg.r~¢�vcilon, Total Fee. b Perm. i
and heraby.outhorize representatjves of this Courtty.to enter
upon the abov*-mentioned properly for rhspectiorl purposes.
fa WVmw.POR DQLA!•IATo[Y LAWWAGE
SI¢wtvre at Ikant or Agent